The American Society of Clinical Oncology (ASCO) has published a free, downloadable resource that identifies oncology billing and coding updates for 2016. Topics discussed include the following: New CPT codes (99415 and 99416) Radiation oncology CPT updates New HCPCS codes (J8655, J7508 and J7503) Deleted HCPCS codes Filgrastim HCPCS updates Chemotherapy drugs (replacements) HCPCS codes […]
Improve Your Coding in 2016: 5 Tools to Use
Proper medical coding is critical for many reasons. They include receiving proper payment for services rendered, limiting denials and maintaining compliance with payor rules. Throughout 2015, PGM Billing launched a number of practice management tools that help ensure proper coding. These tools are free to access and use, and can be shared with coworkers and […]
4 ICD-10 Changes to the Laboratory National Coverage Determination Edit Software for January 2016
The Centers for Medicare & Medicaid Services has announced four changes that will be included in the January 2016 quarterly release of the edit module for clinical diagnostic laboratory services. The changes being made to the National Coverage Determinations (NCD) code lists as follows: Addition of ICD-10-CM codes N131 and N132 to the list of […]
CMS Issues 2016 HCPCS Update
The Centers for Medicare & Medicaid Services (CMS) has posted its final Level II HCPCS application determinations for 2016. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, […]
CMS Discusses Payment Errors Associated With Co-Surgeon Modifier -62
The Centers for Medicare and Medicaid Services (CMS) recently released a Medicare Learning Network podcast intended to clarify CMS’s existing policy regarding payments errors because of a failure to apply properly the co-surgeon modifier -62, when two or more surgeons of different specialties participate in one operative session and each separately submit claims to Medicare. […]
FAQs About CPT Coding and Reimbursement for Psychiatrists
Following substantial changes to the current procedural terminology (CPT) psychiatry codes, the American Psychiatric Association updated its frequently asked questions (FAQs) about coding and reimbursement for psychiatrists. The update occurred in March. If your organization performs mental health billing and coding, these FAQs may be a valuable resource to review. The following are the questions […]
Latest Issue of ACR Radiology Coding Source Includes Guidance on Lung Cancer Screening, Modifier Use
The January/February 2015 issue of the American College of Radiology‘s (ACR) Radiology Coding Source is now available, and it discusses many topics that should be of interest to any organization that performs lab billing and coding. The current issue, released late February, includes the following: Answers provided by ACR to questions about Medicare requirements, standards […]
AAP Addresses Question on Coding for Behavioral Assessment vs. Developmental Assessment
The American Academy of Pediatrics‘ Division of Health Care Finance and Practice Improvement, in a recent issue of AAP News, has addressed a coding question that should be of interest to providers of pediatric mental health services. The question concerns coding for emotional/behavioral assessment versus developmental assessment. As AAP notes in the Coding Corner column, […]
CMS Issues Clarification on Continued Use of Modifier -59
As we previously reported, four new HCPCS modifiers that define specific subsets of the -59 modifier went into effect January 1, 2015. These new HCPCS modifiers — -XE, -XP, -XS, -XU — are referred to collectively as -X{EPSU} modifiers. The Centers for Medicare & Medicaid Services (CMS) has published a new MLN Matters Article (SE1503) […]
Medicare Provides Guidance on Proper Coding of Facet Joint Injections
Medicare has provided guidance on how to properly code facet joint injections after its Recovery Audit Program identified claims resulting in overpayments. This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors […]